Light-directing surgical retractor instrument



June 24, 1958 B. F. TOFFLEMIRE 2,840,070

LIGHT-DIRECTING SURGICAL RETRACTOR INSTRUMENT Filed March 9, 1956ATTORNEYS United States Patent 2,840,070 LIGHT-DIRECTING SURGICALRETRACTOR INSTRUMENT Benjamin F. Tofllemire, Lafayette, Calif.Application March 9, 1956, Serial No. 570,498 2 Claims. (Cl. 128 11) Thepresent invention relates to improvements in a light-directing surgicalretractor instrument. It consists of the combinations, constructions andarrangement of parts, as hereinafter described and claimed.

It is a well-known fact that the function of surgical retractors, intheir generally accepted use, is the holding and traction exerted uponthe edges of surgically-incised tissues, causing a dilation or spreadingof these edges, thereby providing greater accessibility and visibilityfor the surgeon and operating team.

This retracting function, also, might include the spreading or holdingof non-incised tissues away from the site of the surgery, in order toprovide greater accessibility and visibility, such as the holding of thebuccal tissues away from the alveolar area in oral surgery.

Retractors have long been used in surgery in various parts of the body;and they usually consist of a hook, which is shaped to conform to theedges of the tissues to be retracted or drawn apart. These retractorsfurther include a handle portion which is angularly related to the hookin such a manner that the assistant can apply traction in the directionneeded and, at the same time, be in such a position as to afford thesurgeon substantially unobstructed view of the operative field.

However, there has been one outstanding shortcoming in the design andfunction of surgical retractors in the past, and this is the absence ofan on-the-spot source of artificial illumination. Frequently the hook ofthe retractor must be submerged deeply in the various body cavities,which are devoid of light. For example, in abdominal surgery, the hookof the retractor may curve beneath superimposed organs and tissues,which often obscure the outside light which is being directed toward theoperative field by directional lighting. The actual site of theoperative work is confronted with confusing shadows in the deeperportions and a masking surface glare, which tends to blind the operativevision at the actual site of the involved surgery. Of course, similarsituations prevail in thoracic, inguinal, renal and oral surgery.

An object of my invention is to provide a surgical retractor which has aspoon portion having a very compact, miniature electric lampincorporated within its spoon, without adding bulk or otherwisedetracting from the functional value of the retractor itself. Thus anonthe-spot source of artifical illumination is provided in the operativefield.

Moreover, during traction, the light-directing function of theinstrument is always available whenever and whereever needed. Thedirection and elevation of the light may be further influenced by theassistant simply tilting or slightly rotating the handle of theretractor, if needed, for example, in deep visceral surgery. In otherwords, my improved retractor directs the light where it is needed, andthe illumination thus provided is not subject to shadows, and noblinding glare is present to distract the sur- 0 Drawing For a betterunderstanding of my invention, reference should be had to theaccompanying drawing, forming part of this specification, in which:

ice

Figure 1 is a horizontal plan view of my light-directing surgicalretractor instrument, partly in section, and disclosing it as being usedfor holding the buccal (cheek) .tissues of the patient away from thealveolar (that part used in connection with an abdominal operation.

While I have shown only the preferred form of my invention, it should beunderstood that various changes, or modifications, may be made withinthe scope of the annexed claims without departing from the spiritthereof.

Detailed description 0 Referring to the drawing in detail, mylight-directing surgical retractor instrument has been designated generally at A. In its structural features, the instrument includes a spoonportion B having a handle C secured thereto by a curved section 10. Thisspoon portion is shaped to conform to the edges of the tissues to beretracted; while the handle is angularly related to the spoon so that anassistant can apply traction without obstructing the surgeons view ofthe operative field.

As shown in Figures 2 and 3, spoon portion B is generally oval-shaped inmarginal outline, defining a concave front face 11 and a convex rearface 12. It will be noticed that the retractor spoon has smooth androunded marginal edges 13, which are designed to conform to the tissuesbeing retracted.

For the purpose of providing direct illumination to the operative field,a small electric lamp D has been inserted into a socket 14 fashioned inthe spoon portion B. The light rays emanating from this lamp passthrough an aperture 15, which is fashioned in the central portion of thespoon. This aperture is funnel-shaped, flaring outwardly in thedirection of the concave face 11 of the spoon, that is, toward the siteof the surgery. The peripheral wall 16 defined by this aperture providesa protective guard over the lamp D, preventing accidental breakage ofthe latter in the event of an unavoidable impact in the course of theoperative procedure. However, the aperture permits the free passage oflight ray to the locale of the surgery being performed.

For the purpose of reflecting light from the lamp D through the aperture15, a reflector E is mounted on the spoon B rearwardly of the lamp. Theinner concave surface 17 of this reflector is preferably parabolic inshape to thus direct parallel rays of light through the aperture. Asshown in Figures 1 and 4, the outer convex surface 18 of the reflectoris adapted to bear against the buccal tissues F and the abdominaltissues G, respectively. The reflector provides a closure over theaperture 15 at the rear face of the spoon portion B, thereby precludingtissues of the patient from being pressed into the aperture from therear of the spoon portion.

It will be apparent that both the direct and the reflected rays willpass through the orbit-like aperture 15, and the rays will illuminatethe. field of operation. The handle C may be readily tilted or rotatedto follow the cotu'se of the surgeons operative procedure.

With particular reference to Figure 1, wherein for the purpose ofillustration only, my light-diiecting surgical retractor has beenapplied over the cheek H of the patients mouth so as to withdraw thebuccal tissues F from the alveolar 19 in which the teeth I of the lowerleft quadrant are set, it will be obvious that the spoon B provides anextensive dome-like canopy over the field of operation. These tissuesmay be held away from the site of the operation; and, at the same time,the operative field will be flooded with a non-glaring light, withoutcasting shadows. I

Asshown in Figure l, amplespace is afforded by the concave face 1 11.for rotating surgical burs, diamond wheels orstones, where they may beoperated Without any liklihood of entangling surrounding and contiguoustissues. In operative dentistry, the spoon B permits the cheek to beheld away from abutting the grinding stones and diamond wheels employedby the dentist.

.Of course, any suitable means may be provided for furnishing thenecessary electrical energy to the lamp. For this purpose, a casing 20has been shown for housing one or more dry cell batteries 21. The handleC may be fashioned with an enlarged socket 22 at its lower end, intowhich the upper end of the casing 20 may be removably inserted. In orderto anchor the handle to the casing, a set-screw 23, or other suitablefastening means, may be provided.

It will be noted that a metal conduit K has been shown as extending fromthe batteries to the lamp. The electrical circuit. may include aninsulated Wire enclosed within of the lamp D. The other side of theelectrical circuit may be provided by grounding the lamp D and thebatteries 21 to the socket 14 and the casing 20, respectively.

As shown in Figure 1, the conduit K may be projected downward in a bore24 fashioned lengthwise in the handle C, with a set-screw 25 removablyanchoring the conduit in place, wherein the terminal 21a and the contact21b will remain in engagement. This conduit is substantially J-shapedand defines a curved portion 26 which is adapted to be accommodated in agroove 27, the latter being fashioned in the upper part of the curvedsection ofthe retractor to extend between the bore 24 and the socket 14.Thus, when the set-screw 25 is loosened, the conduit K and its lamp Dmay be withdraw to allow the latter to be replaced, as suggested by thedot dash lines in Figure 1 of the drawing. The conduithas a straightstem 26a telescoped into the bore 24, and further has a tip 26b disposedin the socket 14. The conduit K and the lamp D may be withdrawn as aunit through the groove 27 at the top of the instrument.

It will be noticed that a cap 20a is removably threaded into the lowerend of the casing 20 to allow the batteries 21 to be inserted or removedfrom the casing, with a' coil spring 2011 being inserted between the capand the batteries. When this cap is partiallyunscrewed, the centralcontact 2112 of the upper battery will be separated from the terminal21a to thus extinguish the light. In other words, the cap 20a serves asa switch in the electrical circuit.

Although the source of current has been disclosed in the drawing asbeing provided by dry-cell batteries so as to have a self-containedinstrument, it is obvious that the current could be supplied from thelower voltage transformer in the operating room or dental unit. However,the battery-powered instrument may be used during power-shortageemergencies, and may be readily stored in a cabinet or the surgeons bag,available when needed. The transformer-powered unit requires anextension cord. Either type of current supply is dependable andeflicient.

It will be observd from Figure 4 that a pair of my light-directingsurgical retractors A have been applied to the opposing 'edges of anincision 28, which has been made in the abdominal tissues G. Theseretractors may be pulled in opposition directions to expose the organs Mto thus give the surgeon a clear view of the operative to have theretractor portion, which is defined by the spoon B and the handle C,free from objectionable bulk or irritating projection of material incontact with the patients tissues, thereby making the instrument equallyapplicable for surgery done under general anesthesia, or regional blockor infiltration obtundents. The handle portion C is angularly-attachedto the spoon B in such a manner that the most efficient traction can beexerted, in the required planes, with the minimum of effort and fatigueon the part of the assistant, and with a minimum of compartmentobstruction or interference with the entire visual field of the surgeon.Moreover, the lightdirecting mechanism is so compactly designed that itdoes not add materially to the over-all bulk of the instrument.

I claim:

1. In a light-directing surgical retractor instrument: a spoon portionhaving a handle secured thereto to project therefrom; the spoon portionand handle providing a retractor which is engageable with a patientstissue to retract the latter to expose an operative field; the spoonportion defining front and rear faces which are concave and convex,respectively; a socket provided in the spoon portion betweenthesetfaces; a lamp mounted in the socket; the spoon portion beingformed with an aperture in front of the socket and extending from thelamp to the front face of the spoon portion, with the aperture beingpositioned for the passage of light therethrough from the lamp tothereby illuminate the operative field forwardly of the front face ofthe spoon portion, while the tissue is held in retracted position; saidaperture being funnel-shaped and flaring outwardly towards the frontface of the spoon portion, with the peripheral wall of said apertureproviding a protective guard in front of the lamp, which is disposed toprevent accidental breakage of the lamp in the event of an unavoidableimpact in the course ,of operative procedure; and a reflector mounted inback of the lamp and being secured to the spoon portion to provide aclosure over the aperture at the rear face of the spoon portion, therebyprecluding the patients tissue from being pressed into the aperture'from'the rear of the spoon portion.

extending from said bore to the socket; a substantially J-shapedmetallic conduit having a straight stem telescoped into said here of thehandle, and further defining a curved portion removably accommodated insaid groove; the conduit having a tip portion provided with a lamp, thelatter being disposed in the socket of the spoon portion in registrationwith said aperture; and a source of electrical power connected throughthe conduit to the lamp forlighting the latter; said conduit and lampbeing withdrawable as a unit through said groove at the curved sectionof the handle.

References Cited in the file of this patent UNITED STATES PATENTS299,277 Sheridan May 27, 1884 300,523 Starr June 17, 1884 2,492,427Hoefiing Dec. 27, 1949 FOREIGN PATENTS 302,757 Italy Q. Nov. 8, 1932OTHER REFERENCES Dental Cosmos for .1929, pp. 532-3; sion 55.

Copy in Divi-

